Settaf A, Bargach S, Aghzadi R, Lahlou M K, Oudghiri M
Association de Recherche de Chirurgie Hépatique, Hôpital Universitaire Avicenne, Souissi, Rabat, Maroc.
J Chir (Paris). 1991 Mar;128(3):133-8.
33 hydatid cysts of the liver, opened into the biliary tract were reviewed. The biliary fistula was located in the biliary tract: 16 cases in the right, 14 cases in the left, 1 case in the common bile duct, and 3 cases in the gallbladder. (One case had fistula in the gallbladder and the anterior sectorial canal). Surgical treatment was conservative in 21 cases: bipolar drainage in 10 cases and cysto-biliary disconnection in 11 cases. The treatment was radical in 12 cases: Pericystectomy in 5 cases and liver resection in 7 cases. One postoperative death was observed following bipolar drainage-Postoperative biliary fistula was seen in 8 cases, 7 among them appeared following bipolar drainage. The present results prove the inadequacy of bipolar drainage that should be avoided in large fistula. Better results were observed with radical methods with low morbidity and no mortality. When radical methods are impossible, cystobiliary disconnection seems to allow efficient treatment of cystobiliary fistula with very good immediate and long-term results.
回顾了33例向胆道破溃的肝包虫囊肿。胆瘘位于胆道：右侧16例，左侧14例，胆总管1例，胆囊3例。（1例胆囊和肝前叶胆管均有瘘）。21例采用保守手术治疗：10例行双极引流，11例行囊肿-胆道离断术。12例采用根治性治疗：5例行囊肿切除术，7例行肝切除术。双极引流术后观察到1例死亡——术后胆瘘8例，其中7例发生在双极引流后。目前的结果证明双极引流并不充分，在大的瘘管中应避免使用。根治性方法的效果更好，发病率低且无死亡率。当无法采用根治性方法时，囊肿-胆道离断术似乎能有效治疗囊肿-胆道瘘，近期和远期效果都非常好。
